PROJECT SUMMARY Joanna Thomson, MD, MPH is a pediatrician in hospital medicine whose overarching career goal is to optimize the care and outcomes of children with neurologic impairment (NI). Acute respiratory illnesses (ARI, e.g., pneumonia, bronchiolitis) are among the most common reasons for hospitalization, intensive care unit admission and death for children with NI. Yet, there are currently no evidence-based or consensus-driven recommendations to guide hospital management of this population. In this proposal, Dr. Thomson seeks to identify management practices (e.g., airway clearance strategies) associated with better hospital outcomes and to then develop and implement care recommendations for the hospital management of ARI in children with NI. Recommendations for hospital management of ARI in children with NI will allow for standardization of care and optimization of patient outcomes. Such standardization for otherwise healthy children has resulted in decreased unwarranted testing and therapies while improving patient outcomes and decreasing cost of care Candidate: Dr. Thomson is an Assistant Professor of Pediatrics in the Division of Hospital Medicine and James M. Anderson Center for Health Systems Excellence at Cincinnati Children's Hospital Medical Center (CCHMC). She completed a four-year combined Hospital Medicine and NRSA General Academic Pediatrics Research fellowship. As part of her fellowship training, she obtained a Master of Public Health degree in Clinical Effectiveness at the Harvard University School of Public Health. She has conducted multiple studies focused on the care and outcomes of children with NI. The proposed K08 career development plan will build upon her fellowship training to address four areas where she requires additional development to enhance her trajectory toward becoming an independent investigator: 1) comparative effectiveness research methods, 2) patient-centered participatory research methods, 3) design and study of complex clinical interventions, and 4) the conduct of multicenter research. The proposed training will provide Dr. Thomson with the necessary expertise and skills to conduct multicenter clinical trials implementing evidence-based care recommendations. Mentors/Environment: Dr. Thomson has assembled a mentorship team with clinical expertise in pediatric ARI (Shah) and chronic and complex care (Britto, Berry). Her mentors additionally provide methodologic expertise in comparative effectiveness research (Shah, Berry), patient-centered participatory research (Shah, Britto), implementation science (Britto, Srivastava), and multicenter pediatric research (Shah, Berry, Srivastava). The proposed career development plan utilizes the broad intellectual resources available through CCHMC and the University of Cincinnati, as well as focused national seminars to complement local training. CCHMC is committed to supporting junior faculty members through structured opportunities for education, networking, and internal grant funding. The Division of Hospital Medicine at CCHMC provides Dr. Thomson with extensive support including computers and software, biostatistical advisors, data management support, clinical research coordinators, grants management support, and discretionary funds. Dr. Thomson is also a member of CCHMC's James M. Anderson Center for Health Systems Excellence, a nationally renowned for its research on improving pediatric health care delivery. Research: Despite the importance of ARI to health outcomes of children with NI, there are currently no recommendations to guide hospital management of ARI for this high-risk population. This proposal will begin to fill that gap. Aim 1 will augment the AHRQ-funded Pediatric Health Information Systems Plus (PHIS+) database with target medical record review to compare the effectiveness of common hospital management practices (e.g., airway clearance strategies, inhaled beta agonists, corticosteroids). Aim 2 will bring together parents of children with NI and expert clinicians to critically review existing evidence and develop care recommendations for hospital management of ARI using the RAND-UCLA Appropriateness Method. Aim 3 will test the face validity, acceptability, and feasibility of implementing the care recommendations at a single hospital as well as evaluate the preliminary efficacy of care recommendations. This research will result in family and clinician co-developed care recommendations and tools for effective implementation into the clinical care of children with NI hospitalized with ARI. Summary: This proposed innovative research will expand the evidence base for the management of ARI in children with NI. Partnering with families of children with NI and clinical experts, care recommendations will be developed and implemented. The resulting set of tested implementation strategies will facilitate efficient spread of clinical change in future work. Aligned with AHRQ's mission, this work will be an important contribution to improving the quality, efficiency, and effectiveness of care delivered to children with NI. Dr. Thomson's research and clinical training, prior research experiences, and dedicated mentorship team make her ideally suited to pursue this research. This award will facilitate Dr. Thomson's continued development into an independent investigator in the conduct of multicenter patient-centered outcomes research and a national leader in optimizing the care and outcomes of children with NI.